Forensic age estimation in Barcelona: analysis of expert reports issued between 2011 and 2018.

INTRODUCTION: In recent years, there has been a notable increase of migratory movements into Europe with the arrival of not (reliably) documented young individuals within EU-Member States. Accordingly, the need for forensic age assessments likewise increased in order to administratively differentiate along the legally relevant cut-off age of 18 completed years. The objective of our study was to analyse the expert reports of forensic age estimation issued in Barcelona between 2011 and 2018. METHOD: In all cases, data on the medical history, physical examination, radiology of the left hand and orthopantomography were collected. In cases without third molars and a complete ossification of the hand, a CT scan of the clavicles was also performed. RESULTS: A total of 2754 expert reports were evaluated; 96.7% were males, the majority were of North African origin, mainly from Morocco (63.6%), and 19.6% were sub-Saharan Africans; 65.4% had a level of bone maturation corresponding to the last three standards of Greulich and Pyle. Most cases had mineralization of the third molar corresponding to the F, G or H stages of Demirjian. In 85.9%, there was a correspondence between bone and dental age. A total of 28.8% of the subjects were evaluated as being aged over 18 years; 86.2% of North Africans were considered to be younger than 18, and 82% of sub-Saharan Africans were considered to be over 18 years old. CONCLUSIONS: In Barcelona, most of the subjects evaluated were male and North African, and 71.2% of the cases were considered to be minors.

Las catástrofes llegan sin avisar. ¿Estamos preparados? / Catastrophes come without warning. Are we ready?

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Las muertes con intervención judicial y medicolegal y su impacto en la estadística de causas de muerte en Cataluña / Deaths with medicolegal intervention and its impact on the cause-of-death statistics in Catalonia, Spain

Introducción. Los boletines estadísticos correspondientes a las defunciones que requieren intervención judicial (DIJ) y actuación forense contienen un número elevado de causas de muerte mal definidas. El objetivo es presentar los resultados de la recuperación de datos a partir de las autopsias judiciales del año 2013 en Cataluña y analizar el impacto de esta información sobre la estadística de causas de muerte. Material y métodos. Se seleccionaron del Registro de Mortalidad de Cataluña las defunciones con intervención judicial que tenían como causa de muerte unas determinadas afecciones mal definidas, según criterios de codificación de la OMS. Se recuperó la información de los registros de autopsia de los centros de Patología Forense del Instituto de Medicina Legal y Ciencias Forenses de Cataluña (IMLCFC). Resultados. Las DIJ representan el 6% de la mortalidad total de Cataluña, el 42,9% de las causas externas y el 77% de las mal definidas. De los 3.639 casos de DIJ del año 2013 se revisó un 43,4% (n=1.578) y se obtuvo información que mejoró la causa de muerte del 78,4% de los revisados. La información recuperada aumentó un 61,3% las intoxicaciones accidentales, un 32,6% los suicidios, un 28,9% los homicidios, un 27,4% las caídas, un 22,7% los accidentes de tráfico y un 5,2% la cardiopatía isquémica, con el equivalente aumento de las tasas de mortalidad por estas causas. Conclusiones. La información de las autopsias judiciales tiene un gran impacto en las estadísticas de causa de muerte, especialmente en las causas externas y la cardiopatía isquémica. Un informe forense sobre la causa y las circunstancias de la muerte, de manera que permita fácilmente su codificación posterior, así como la transmisión directa de estos datos a la oficina estadística serían la mejor solución para evitar la pérdida de información que se produce actualmente (AU)

Introduction. The statistical forms corresponding to deaths that require judicial and forensic interventions contain a very high number of ill-defined causes of death. The objective is to show the results of data recovery from the forensic autopsies and to analyse the impact of this information on the cause-of-death statistics for the year 2013 in Catalonia (Spain). Material and methods. Deaths with judicial intervention with an ill-defined cause of death according to the WHO coding standards were selected from the Catalan Mortality Registry. Information was recovered from the autopsy registers of the Forensic Pathology centres of the Institute of Legal Medicine and Forensic Science of Catalonia (IMLCFC). Results. Deaths with judicial intervention represent 6% of total mortality in Catalonia, 42.9% due to external causes and 77% pertaining to ill-defined causes-of-death. There were 3,639 cases of death with judicial intervention, of which 43.4% (n=1,578) were reviewed, resulting in information that improved the cause of death in 78.4% of cases. The information retrieved increased accidental poisoning by 61.3%, suicides by 32.6%, homicides by 28.9%, falls by 27.4%, traffic accidents by 22.7% and ischaemic heart disease by 5.2%, with the equivalent increase in the mortality rates from these causes. Conclusions. The forensic autopsy information has a significant impact on cause-of-death statistics, especially external causes and ischemic heart disease. A forensic report concerning the cause and circumstances of death, structured to facilitate further coding and the direct transmission of data to the statistical office, would be the best solution to prevent the loss of information currently experienced (AU)

Fractura de radio por proyectil que permite reproducir la posición de la víctima / Fracture of radius by projectile allowing to reproduce the position of the victim

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Nódulos hialinos epicárdicos / Epicardial hyaline nodules

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Fallecimiento de origen cardiaco tras visita médica y alta: ¿de qué murió mi paciente? / Ductus arteriosus closure with paracetamol: a pilot study

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Entrenamiento en la identificación de víctimas múltiples en el Instituto de Medicina Legal de Catalunya: lecciones aprendidas / Identifying tracking disaster victims in Instituto de Medicina Legal de Catalunya: learned lessons

Los principales problemas fueron la numeración en el levantamiento de cadáver-zona de registro, la coordinación médico forense-policial y en la zona del control de calidad. A pesar del buen resultado se evidenció la necesidad de formación especializada; realizar simulacros parecidos multidisciplinares y de adecuación de la normativa a las instalaciones propias. Ante un suceso con víctimas múltiples debemos adaptarnos a la legislación vigente (Real Decreto 32/2009: protocolo nacional de actuación médico-forense y de Policía Científica en sucesos con víctimas múltiples). El objetivo principal de nuestro estudio fue valorar la respuesta médico-forense mediante un simulacro con atentado bomba, con 11 individuos fallecidos siguiendo la mencionada legislación. En el levantamiento había 8 cuerpos y 22 restos. La duración programada fue de 5h. En este tiempo estaban muy avanzadas las identificaciones de 8 personas (5 mediante estudio necrodactilar, odontología y ADN y 3 mediante estudio necrodactilar y ADN)(AU)

When a disaster involving multiple victims occurs we must comply with the legal norms in force in Spain (Royal Decree 32/2009, enacting the National Protocol for the Intervention of Forensic Doctors and Scientific Police in Mass Disaster). The main aim of our study was to assess the response of Forensic Doctors through a practice simulating a bomb attack with 11 mortal victims. At the disaster scene there were 8 bodies and 22 corpse remains to be identified. The expected duration was 5 hours. In that time the identification of 8 persons was well under way (5 using fingerprint identification, odontology and DNA, and 3 using fingerprint identification and DNA). The numbering of the bodies at the specific area of the disaster scene, the coordination of Forensic Doctors and Scientific Police and the management of the quality control area were the main problems. Despite of the good results achieved, the need for specialised training of the professionals participating in this type of intervention, the need to conduct similar multidisciplinary exercises, and the adaptation of the protocol to the specific guidelines of the Catalan Institute of Legal Medicine was evident(AU)